| NPI | 1023087244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA002178) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA003306L) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2023-06-02 |